Provider Demographics
NPI:1346239019
Name:AUBREY, JOHN RONALD (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RONALD
Last Name:AUBREY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15901-2824
Mailing Address - Country:US
Mailing Address - Phone:814-535-8697
Mailing Address - Fax:814-535-8698
Practice Address - Street 1:722 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15901-2824
Practice Address - Country:US
Practice Address - Phone:814-535-8697
Practice Address - Fax:814-535-8698
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001204152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008490500003Medicaid
PA0008490500003Medicaid
PA60162Medicare ID - Type Unspecified